But now we know that even the jewel in the homeopaths' crown, the RLHIM, no longer has a homeopathy service.

We've known this for some time as it was admitted by them in their response to a Freedom of Information Act request last year and this service has not been mentioned on their website for some time. It is now public thanks to someone else's FOIA request. All they provide now are:

Acupuncture Services

Adult Allergy Service

Allergy Service

Chronic Fatigue Service

Children’s Service

Complementary Cancer Care Service

Fibromyalgia Syndrome Service

General Medicine Service

Hypnosis Service

Insomnia Service

Irritable Bowel Syndrome Service

Musculoskeletal Medicine Service

Nutrition and Dietetics

Podiatry Service

Rheumatology Service

Skin Service

Psychological Services

Weight Loss Service

Women’s Service

But no homeopathy service. For their flagship hospital, closing that down must have been a bitter sugar pill to swallow.

Even though homeopathy isn't mentioned they still provide it under the guise of other services. The list of services doesn't match those listed on their website (and there are some interesting differences), but some do include homeopathy:

Ainsworths

After Nelsons were reprimanded in August (as a result of our complaint), another homeopathy manufacturer was today admonished by the medicines regulator, the MHRA.

As part of MHRA’s regular review of advertising, we reviewed the Ainsworths website. Some unlicensed homeopathic remedies had the name of a commonly recognised disease or medicine. We were concerned that this could be seen as a claim to treat or prevent that disease. We were also concerned that remedy kits containing unlicensed remedies were being promoted for sale in the UK.

Ainsworths agreed to remove the name of the disease and the medicine names from unlicensed remedies on their price list and amend the web pages with remedy kits.

It's encouraging to see that the MHRA instigated this themselves rather then waiting for a complaint from a member of the public or a pharmacist, but it's disappointing that they have not given details of what products they were concerned about.

In terms of the kits, they have been in trouble before, so it's disappointing to see them being pulled up again, apparently for exactly the same breach of the medicines regulations.

Note that the decision is dated 10 June, yet the decision was only published today. It's therefore even more disappointing and concerning to see Ainsworths still advertising unlicensed remedies such as these:

We sincerely hope that Ainsworths will comply with the MHRA's instructions to remove all products with the name of a commonly recognised disease or medicine, and — in the interests of not misleading the public — products that have names very similar to commonly recognised diseases or medicines. We're sure Ainsworths would not want to mislead consumers but we hope the MHRA will continue to monitor their website and take further action as necessary to protect consumers.

It's not clear to us why these decision notices are so void of any details that would help consumers: the Advertising Standards Authority (ASA) by contrast, when they publish an adjudication, give full details of the complaint, their investigation, the advertiser's response, their decision and the sanctions applied. For example see this ASA adjudication against another homeopathy manufacturer, Ainsworths.

The issues we highlighted to the MHRA were mostly about the advertising of homeopathic products that was not within the terms of the authorisation or registration for those products. For example, their Arnicare Arnica 6C product stated:

Indications: For the symptomatic relief of sprains, muscle aches, bruising and swelling after contusions.

However, this is a Homeopathic Rules (HR) scheme product and its registration does not permit therapeutic indications. Instead, all advertising for HR products must simply contain the text:

It's a moot point whether the general public understands this to mean that there is not a jot of good evidence that these products have any therapeutic effects whatsoever, a point raised by the House of Commons Science and Technology Select Committee in their Evidence Check on homeopathy.

Another page advertising their Aconite 30C National Rules (NR) scheme product contained the following instructions:

Adults and children: Take 2 pillules every 2 hours for the first 6 doses, then 4 times daily until symptoms improve for up to a maximum of 7 days.

Pillules should either be chewed or placed under the tongue until dissolved.

Although it makes not the slightest difference to the 'effectiveness' of the homeopathic product, there is no mention of dissolving in warm water as a permitted method of administration.

The other issues covered by this decision were similar to these and we suspect they were simply oversights by Nelsons — they have now corrected them.

In total we identified eight issues with the advertising of their products on their websites, including the ones above. When the MHRA told us of their decision, we queried a couple of points and we're waiting for a further response from them. We'll let you know when these have been satisfactorily resolved.

However, the issues the MHRA have dealt with were just part of our larger complaint to both the MHRA and the General Pharmaceutical Council (GPhC), the statutory regulator for pharmacies and pharmacists. Once the GPhC have completed their investigations into all the other issues we raised, we'll let you know.

We know that boosting the immune system is a common claim made by advertisers of alternative therapies and supplements and something they might like us all to think is good for us. In fact, it turns out that boosting the immune system is not such a good idea at all.

The testimonial in the advert could also give the impression that arthritis sufferers using this product can stop using painkillers.

As has been noted elsewhere, there is frequently a connection between adverts and articles, and this one boasts:

StemTech as featured in WDDTY Jan & March Issues - by Vet Paul Boland

Can stem cell therapy provide these benefits? The product page on the advertiser's website states:

Stemtech’s SE2® is the world’s first all-natural supplement documented to support the release of adult stem cells from bone marrow. Our advanced supplement puts more stem cells in the bloodstream, and the effect lasts longer.

An advancement in Cellular Renewal – helping Nature do what it is designed to do

This 'advanced supplement' doesn't come cheap, of course: a bottle of 60 capsules costs £60.95 (plus shipping), but it might seem a bargain if the claims stood up to scrutiny.

The page for the Jamu product no longer exists and the advertiser appears to have completely removed it from their website, but they had claimed:

Jamu (formerly Djamu) is traditional medicine in Indonesia. It is predominantly herbal medicine made from natural materials, such as parts of plants such as roots, bark, flowers, seeds, leaves and fruits. Materials acquired from animals, such as honey, milk, Ayam Kampung eggs and goat’s bile, are also often used.

…and they listed more than a dozen products in the range with descriptions such as 'Cholesterol Control', 'Naturally Lowers Blood Pressure', 'Naturally Dissolves Kidney Stones' and 'Naturally Reduces Blood Glucose Levels'.

ASA investigation

The ASA originally said they would contact Life Long Products and ask for their comments on several points they identified in the website advert for PainSolv references to pain reduction and management; some of the claims were made in a video on their website, but which is also within the ASA's remit. The advertiser could then provide the required evidence to substantiate the claims or agree with the ASA to remove the claims.

For the other points of the complaint about the supplements and Jamu herbal product, the ASA said those were sufficiently straightforward and would take them up informally with the advertiser, asking them to:

…remove the health and disease claims from their Stem Cell Therapy, Aloe Vera and Serrapeptase, and to remove the Jamu products from their marketing activity.

Although not stated, we believe the Jamu products were unlicensed medicines that would be a breach of the Human Medicines Regulations 2012 to advertise, supply or sell to the public and we're pleased to see that there is now no reference to these products on the advertiser's website.

However, instead of providing evidence to substantiate their claims for PainSolv, the ASA notified us that the advertiser had agreed to:

…implement suitable changes to their website to bring it in line with the CAP Code.

So, instead of an adjudication, the ASA have today published the outcome of our complaint as an informally resolved case.

Except...

Except… although the advertiser has removed all mention of their Jamu products from their website, we see no other changes as yet.

If those pages don't change soon, we'll bring them to the attention of the ASA.

HealthWatch UK

The charity HealthWatch (not to be confused with the recent NHS organisation "Healthwatch England") has a study under way to test the effectiveness of consumer protection laws against misleading health claims.

Because of the number and extent of the claims being made, the points relate to those claims made on the advertiser's website, but the ruling applies to all media where the same claims are made — including WDDTY ads, of course.

Many of our natural health foods are also thought to play a significant part in:

Improving the permeability of your cell membranes

Promoting the health of your eyes, brain and skin

Boosting your immune system

Increasing resistance to a number of degenerative conditions

Chlorella has five main benefits:

Promotes healthy cellular growth and repair to slow down aging

Supports and strengthens the immune system

Is highly alkaline to support a healthy pH in the tissues, and cells.

Detoxifies and helps purify the body

Provides complete nutrition to normalize body function

Chia Seeds are thought to help you:

Support heart health

Stabilize blood sugar

Improve brain power

Enable detoxification

Encourage weight loss

[Organic Flax Seed Oil] will help to:

Keep your skin, nails and hair healthy

Maintain your cardiovascular health

Ensure that your eyes and brain develop properly

Boost your immune system

Improve the flexibility, and permeability, of cell membranes, allowing for better cell hydration

Furthermore, taking an omega 3 Supplement like one of Omega Nutrition’s flax oils is recommended by several natural cancer treatment protocols, including the Budwig program and Gerson Therapy, and recent research also suggests that they may play a part in preventing neurological diseases such as Bipolar disorder.

Broccolo [sic] forte can help you to to [sic]:

promote improved liver function

combat allergens

remove toxins

neutralize toxic, cancer-promoting hormone metabolites

only does it [sic] have a high broccoli sprout extract content, it is combined with 6 other immune boosting plant extracts to further boost its effectiveness.

The phytonutrients in organic prunes are also thought to help neutralize many of the harmful oxygen free radicals implicated in the development of:

Cardiovascular disease

Breast cancer

Prostate cancer

Alzheimer's disease

Gastric Cancer

Chronic fatigue syndrome

And some testimonials:

“I love the water. My skin is healing in front of my eyes.”

“All of the above have enabled me to reduce my prednisolone (steroids) with no difficulties and I can now see the end of their use within the next few months. My health has been turned around.

The ASA listed many of these and condensed them down to two points of complaint:

The Nightingale Collaboration challenged whether:

the claims for the food and food supplements complied with the Code; and

the claims related to alkaline water also complied with the Code.

Water for Health told the ASA that although they disagreed with the issues raised they had revised their advertising.

In their assessment, the ASA cited EC Regulation 1924/2006 on Nutrition and Health Claims made on Foods and pointed out that they were part of their CAP Code, saying:

…only health claims that appeared on the list of authorised health claims (the EU Register) could be made in ads promoting foods and that marketers must also ensure that they met the conditions of use associated with the claims in question. Health claims were defined as those that stated, suggested or implied a relationship between a food, or ingredient, and health.

The Regulation stated that references to general benefits of a nutrient or food for overall good health or health-related wellbeing were acceptable only if accompanied by a specific authorised health claim. Although some claims had been revised, we considered that they retained their original meaning. For example but not limited to, the revisions to the claims for Maximized Turmeric Curcuminoids, Clean Chlorella and Brocco Forte, which we considered were likely to be understood as general health claims, were not sufficient to alter their original impression.

We also considered that in the context of the ad, which included no reference to specific types of detoxification, "enable detoxification" for Chia Seeds, "Detoxifies and helps purify the body" for Clean Chlorella and "remove toxins" for Brocco Forte were likely to be understood to be general health claims. We noted that they were not accompanied by a related specific authorised health claim and were therefore not acceptable.

The ASA detailed the issues they had with the claims made and concluded:

Because the ad made general health claims which were not accompanied by a related specific authorised health claim, and included specific health claims, and a reduction of disease risk claim, for which evidence had not been provided that they were authorised on the EU Register, and because it included prohibited claims that the advertised foods could prevent, treat or cure human disease, we concluded that it breached the Code.

The second point of the complaint was about the claims for alkaline water. The ASA ruled:

Although Water for Health had told us that their ad had been revised, claims for "Alkaline Nutrition" continued to make the same claim that it "has tremendous therapeutic power and is also vitally important to support your body if you are undergoing conventional medical treatment". We considered in the context of the claims for the product's purported benefits for the body, the reference to alkaline nutrition's "tremendous therapeutic power" and that it was "vitally important to support your body" were likely to be understood as a general health claims, which we noted were not accompanied with a related specific authorised health claim as required by the Regulation. Because these general health claims were not accompanied by a related specific authorised claim, we concluded the ad breached the Code.

The ad must not appear again in its current form. We told Water for Health to ensure they did not make general health claims which were not accompanied by a relevant authorised health claim, or to include specific health claims or reduction of disease risk claims which were not authorised on the EU Register, or make claims to prevent, treat or cure human disease for foods.

So another misleading WDDTY advertiser.

Although the adjudication doesn't mention the ad in WDDTY explicitly, as always, the adjudication covers all adverts regardless of the medium: after all, if a claim is misleading in one medium, it will be just as misleading in others.

The latest tally

With this one, we now have 11 adjudications and 12 informally resolved cases against WDDTY advertisers and at least one of these advertisers — and WDDTY regular — Wholistic Research, has now ceased trading:

Guidance

The ASA provide several pages of guidance on the rules for health and nutrition claims for foods including:

The ASA is the UK body responsible for advertisements in broadcast (TV and radio) and non-broadcast media. There are two advertising content codes: the Committee on Advertising Practice writes and maintains the non-broadcast advertising code (the CAP code) and the broadcast committee of advertising practice writes and maintains the TV and radio advertising standards code (the BCAP code). The ASA is the independent body responsible for administering those codes and is able to require advertisers and broadcasts to remove non-compliant claims. The advertising codes reflect the requirements of the Regulation.

With all this advice and guidance, there should be no need for any advertiser to make non-authorised nutrition and health claims for foods. Additionally, the ASA offer free advice to advertisers via their Copy Advice Team as well as other help to prospective advertisers.

No excuse

If Water for Health weren't aware of authorised and non-authorised claims under the Regulations, they are now. We welcome their decision to amend their advertising even if that initially did not go far enough to satisfy the ASA. They have made other changes, but we don't think it yet complies and we hope that they will look again at the claims they made for the products mentioned in the ASA's adjudication and ensure that they are now compliant.

They might also like to check the claims they make about the other products they advertise — whether on their website or in the pages of What Doctors Don't Tell You.

There can be no excuse for not complying with the rules, regulations and laws in place to protect the public.

The information is published annually and the data for 2014 have just been published.

So, has the decline of the previous 17 years been halted?

I've updated my charts to include the new data from 2014.

The complete data for these charts are (all these figures can be verified from the original HSCIC data):

Year

Prescription

Items

Net Ingredient

Cost

Cost/item

1995

164,207

£816,798

£4.97

1996

172,013

£914,983

£5.32

1997

162,421

£937,311

£5.77

1998

157,063

£927,633

£5.91

1999

147,769

£888,274

£6.01

2000

134,164

£831,130

£6.19

2001

127,333

£807,125

£6.34

2002

117,989

£778,749

£6.60

2003

103,940

£714,938

£6.88

2004

94,501

£661,469

£7.00

2005

82,960

£593,316

£7.15

2006

62,679

£442,769

£7.06

2007

49,316

£321,418

£6.52

2008

26,337

£152,300

£5.78

2009

19,005

£100,486

£5.29

2010

16,359

£121,449

£7.42

2011

15,501

£130,601

£8.43

2012

15,262

£143,068

£9.37

2013

13,001

£137,298

£10.56

2014

10,238

£110,438

£10.79

So, what does this show?

In 2014, the number of prescriptions for homeopathy fell for the eighteenth consecutive year, this time by over 21% — the fourth largest percentage fall since 1995 — continuing the downward spiral.

The number of prescriptions are now just 6% of what they were at their peak in 1996 — a fall of over 94%.

The total cost of these prescriptions also fell by 20% to a new low.

The cost per prescription has risen again, this time by 2%, compared to an increase of 13% in 2012/2013.

It's clear that doctors are writing fewer homeopathy prescriptions, but because these figures are for England only, the decisions by NHS Tayside and NHS Lothian in the past few years (and the recent decision by NHS Lanarkshire) to cease funding homeopathy referrals cannot explain this continued decline.

At the start of World Homeopathy Awareness Week, perhaps doctors are now more aware than ever that prescribing 'medicines' for which there is no good evidence can no longer be justified either on medical1 or ethical2 grounds.

Last December, we reported on the re-accreditation of the CNHC by the Professional Standards Authority, giving them what we strongly believe to be unearned and undeserved legitimacy. We also documented the long story of events about how the CNHC had dealt with these 10 complaints — it was long because we felt it necessary to record just how the CNHC had dealt with them.

At the end of that chapter, the 100 initial complaints had been 'informally resolved' by the CNHC and our sample of ten of these that we did not believe had been properly resolved were on hold while we provided a list of the 'specific words' we had concerns about (even though we had already done that). We subsequently provided the CNHC with a list of specific words so that they could have no more excuses for not doing their job and dealing with our complaints.

Down to five

Out of those ten, five were dropped because they were no longer CNHC members, leaving just five. We don't know why these five are no longer registered, but a 50% drop out is interesting. A manifestation of the OfQuack Paradox, perhaps?

If you remember, I provided the CNHC with screenshots of the pages I was concerned about with specific text highlighted in yellow, such as the one on the right. Click here to see that extract in the context of the complete page. Some pages had more text highlighted than others.

That was on 9 July last year, but the CNHC didn't even bother to look at them until January this year! How do I know? I provided the screenshots in a zip file placed in my Dropbox account. For some reason, Google's Chrome browser considered the file to be malicious but it downloaded correctly from Firefox and Internet Explorer. When the CNHC came to look at the file in January, they got an error message. Not knowing what caused this, they said:

In respect of the remaining five complaints, when I try to download via Dropbox the compressed file that contains screenshots of the web pages and copies of documents listed with highlighted text, using the link you sent me, I receive a ‘malicious download warning’. I would be grateful if you could check your zip file and send me a fresh link.

I carefully and deliberately asked:

Regarding the zip file, I don't understand what the issue is: can you tell me if you have had any trouble downloading the file previously?

The reply:

I got the same warning message when I tried to download it originally but didn’t raise it with you at that time because you were stating then that your complaint was about every word on every page.

So, even though I had provided the CNHC with screenshots of the pages I was concerned about with the words I was concerned about highlighted for them to see last June, they hadn't bothered looking at them.

The CNHC never confirmed whether they did, finally, look at the screenshots I had provided.

However, on 5 February this year, I was told that the first complainant — a hypnotherapist — had provided:

…evidence that the wording on her website about which you complained is in line with very detailed advice that she received from the Committee of Advertising Copy Advice Team in December 2013. I can confirm that this complaint has been resolved informally.

A few days later, a second one was also 'informally resolved', the registrant having provided:

…published RCT evidence to support claims in respect of all but two of the 10 conditions/symptoms that appear on the acupuncture page on the Longfield Polytechnic website. The two are overactive bladder syndrome and temporomandibular (TMD/TM) pain.

References to them have been removed from the website page. I can confirm, therefore, that the complaint has been resolved informally.

A third was 'informally resolved' on 12 February; a fourth on 6 March and the final one on 20 March.

So, the CNHC were happy that they had informally resolved them and that these were now fully compliant. But did we agree?

Helen Barnard

Let's look at the fourth one that the CNHC told us was now 'informally resolved'. This registrant's website, http://www.helenbarnard.co.uk/, made claims for Bowen therapy. If you've not heard of this particular 'therapy' before, take a few minutes to watch this video from the Bowen Therapy Professional Association, the trade body to which Helen Barnard belongs.

The screenshots of the three pages I sent to the CNHC on 09 July 2014 were (click to enlarge):

The specific words we highlighted to the CNHC on 04 December 2014 were:

Muscle and joint aches and soft tissue injuries including sports injuries, Any age group from babies to elderly, fit and healthy, to frail or chronically ill, Stress related problems from IBS to insomnia, Injury prevention for sports men and women

the relief of pain, improved range of movement and a general feeling of well-being and relaxation. , it is suitable for all ages and fitness levels, from young babies to the frail and elderly. It can be used on acute injuries and sport injuries to chronic conditions.

Advice and guidance

This technique uses pressure to mobilise soft tissue. CAP accepts that marketers can make claims about relieving stress or anxiety and helping relaxation. In August 2012, the ASA upheld a complaint about general claims that the Bowen technique could increase flexibility and improve movement (The Bowen Consultancy, 22 August 2012). Although it rejected some claims, the ASA accepted that the Bowen technique could improve flexibility, in the short term, of hamstring muscles in healthy, fit adults aged 18-50 years with no musculo-skeletal symptoms. Claims to improve flexibility would need to be qualified in those terms. Neither CAP nor the ASA has seen evidence that the technique can treat other conditions and advertisers should not refer to conditions for which medical supervision should be sought (Howard Bult, 8 February 2012).

It should be clear to many that the claims made by Helen Barnard are problematic at best.

On 06 March 2015, the CNHC told us:

Having received advice from the Committee of Advertising Practice Copy Advice Team, Ms Barnard has removed from her website the following wording

"The subtle and gentle nature of Bowen treatment means it is suitable for all ages and fitness levels, from young babies to the frail and elderly. It can be used on acute injuries and sport injuries to chronic conditions. However, practitioners do not diagnose, nor do they prescribe or alter medication. They may recommend assessment by a Doctor. Bowen is not intended as a substitute for medical treatment."

"Gentle fingertip pressure in precise locations can help any age group from babies to elderly, fit and healthy, to frail or chronically ill."

and replaced it with

“The subtle and gentle nature of Bowen treatment means I have clients of all ages from young children to the elderly”.

She has also removed any reference to specific health conditions for which suitably qualified medical advice should be sought.

I confirm that this complaint has been resolved informally.

Here are the before and after screenshots of the changed text (click to enlarge):

This was the only page to change but it's good to see that the advertiser removed some of these words. But why has it taken the CNHC two attempts to get this website changed? They have twice told us all the websites we complained about had been rectified and that they were now compliant.

But, even after all that, are they?

Before we look at that, the CNHC's phrase 'health conditions for which suitably qualified medical advice should be sought' is significant.

The ASA's CAP Code states that they will not allow many advertisers to make claims for some more serious conditions. In their Health, beauty and slimming marketing communications that refer to medical conditions Help Note, CAP provides two lists: the first identifies medical conditions for which medical advice from a suitably qualified person should be sought and the second identifies conditions which could legitimately be referred to in marketing communications without breaching Rule 12.2 (subject to them complying with all other appropriate Code Rules, of course). This Rule states:

Marketers must not discourage essential treatment for conditions for which medical supervision should be sought. For example, they must not offer specific advice on, diagnosis of or treatment for such conditions unless that advice, diagnosis or treatment is conducted under the supervision of a suitably qualified health professional. Accurate and responsible general information about such conditions may, however, be offered (see rule 12.11).

Health professionals will be deemed suitably qualified only if they can provide suitable credentials, for example, evidence of: relevant professional expertise or qualifications; systems for regular review of members' skills and competencies and suitable professional indemnity insurance covering all services provided; accreditation by a professional or regulatory body that has systems for dealing with complaints and taking disciplinary action and has registration based on minimum standards for training and qualifications.

There are, of course, no medical conditions listed by the ASA that they would allow an advertiser of Bowen therapy to claim to treat.

But that's not the whole story. As well as 'health conditions for which suitably qualified medical advice should be sought', the advertiser listed other medical conditions that were not on the ASA's list — as shown on the screenshots above. Why weren't they removed? Why were the CNHC content with the advertiser removing just the more serious medical conditions? The CNHC seem to think they had done their job and declared the case closed.

We were not so easily convinced and we don't think that the CNHC should have been content either; not if they were competently doing their job of protecting the public, that is.

Running out of patience

But we're not the ones to judge these things: that's what the regulators are there to do. In fact all we are able to do is question claims made, submit complaints to the relevant organisation and let them decide according to their own rules and procedures.

We've been extremely patient with the CNHC and already given them two attempts and nearly two years to ensure the websites of the registrants we'd complained about were properly dealt with. We could see no point in trying a third time, so we've submitted complaints to the ASA who we know will deal with the issues professionally, competently and thoroughly, in the interests of protecting the public from misleading claims.

So far, we've submitted three complaints to the ASA about the websites that the CNHC have told us they are happy with and a fourth will be submitted soon.

The outcome of the first of these complaints — Helen Barnard's website — is published today as an informally resolved case. We'll tell you about the others once they've been resolved by the ASA — and what we propose to do subsequently.

Honest and Truthful?

Our ASA complaint was essentially about the same words and some claims made in a video on her website.

The ASA asked her to remove some claims from her website as they had previously been investigated and found to breach the CAP Code. They were going to ask her to provide evidence for the other claims, but she told the ASA she had taken her website down and that if it was live again, it would include her qualifications only.

As far as the ASA is concerned, the case is closed: the misleading claims are no longer being made.

As far as we're concerned, this is not the end.

What we have shown is that, despite the CNHC's assurances that her website was fully compliant, the ASA decided otherwise.

Who should we place our trust in? Who should the public place their trust in? One who sets high standards and adjudicates fairly to protect the public? Or one who claims to but seems to pay lip service to protecting the public from its members?

So, is the CNHC fit for purpose? That depends on whether their purpose is to protect the public or protect their members.